Provider Demographics
NPI:1346551082
Name:PEREZ, DAVID (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1317
Mailing Address - Country:US
Mailing Address - Phone:269-427-7967
Mailing Address - Fax:269-427-7574
Practice Address - Street 1:308 CHARLES ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1317
Practice Address - Country:US
Practice Address - Phone:269-427-7967
Practice Address - Fax:269-427-7574
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015729A207Q00000X
MI5101018510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine